ABSTRACT
Combined myocardial infarction of left and right ventricle (CMILRV) of inferoposterior localization represents simultaneous acute necrosis of both myocardial ventricles and belongs, due to associated and frequent complications, to more severe damages of the myocardium with high mortality. Our group consisted of 100 patients of both sexes, mean age of 67.4 years, of which 50 were with inferoposterior left ventricular infarction and 50 with CMILRV of the same localization. The diagnosis was confirmed clinically, by ECG, by the analysis of enzymes, echocardiographically and scintigraphically using radionuclide ventriculography with 99Tcm PyP. Selective coronarography was performed in all the survived patients, and autopsy of the dead. On the basis of clinical presentation of some forms of dynamic weakness of the heart, in acute stage of CMIRLV, we have established that there are 4 categories of these patients, so that each of these groups represents also a special clinical form, which are: 1. CMIRLV without signs of heart failure, established in 20 (40%) cases, which clinically and prognostically do not differ from inferoposterior left ventricular infarction. 2. CMIRLV with predominant failure of the right ventricle was found in 17 (34%) of the patients with a specific clinical feature and the way of treatment. 3. CMIRLV with marked failure of the left ventricle, found in 8 (16%) of the patients, which required combined treatment measures. 4. CMIRLV with general heart failure, established in 5 (10%) cases, is characterized by cardiogenic shock and falls into the most severe forms of this kind of myocardial infarction. Total mortality in the patients with CMILRV was 10% (5.50), that is 40% (2.5) in both the second and the fourth subgroup, 20% (1/5) in the third group, while in the first one as well as in the control group with inferoposterior infarction there was no mortality. Good knowledge of the above mentioned clinical forms of CMILRV are necessary prerequisite for application of specific and corresponding therapeutic measures and the best prevention of associated complications and high mortality of such patients.
